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[Coronary artery bypass grafting in a patient with severe diffuse lesion and calcifi cation of small-diameter coronary arteries (case report)]. 【冠状动脉旁路移植术治疗严重弥漫性病变及小直径冠状动脉钙化1例(附1例报告)】。
Q3 Medicine Pub Date : 2022-09-30 DOI: 10.33029/1027-6661-2022-28-3-113-119
A A Shiryaev, R S Latypov, E E Vlasova, I I Akhmadov, R A Pashaev, S K Kurbanov, K G Ganaev, V Y Zaikovsky, R S Akchurin

Background: Diffuse atherosclerosis of the coronary arteries with the involvement of distal vessels, extensive calcification and a small diameter of the coronary arteries can be the reasons for refusal of invasive treatment of patients with coronary heart disease. The only option of surgical treatment for these patients is coronary artery bypass grafting, but it is associated with technical difficulties in the creation of distal anastomoses and worse long-term survival. Nevertheless, the use of microsurgical techniques makes it possible to successfully treat such patients.

Patients and methods: A 59-year-old male patient with coronary artery disease was hospitalized for elective coronary artery bypass grafting. Coronary angiography revealed a multivessel diffuse lesion with calcification of the coronary arteries. The estimated severity of coronary atherosclerosis according to the Syntax Score amounted to 39 points. Severe three-vessel distal coronary calcification was confirmed by multislice computed tomography.

Results: Using an operating microscope and artificial circulation, we performed autovenous bypass grafting of the diagonal artery, obtuse marginal artery and posterior descending artery according to the method of extended anastomoses (2 cm long) through the atherosclerotic plaque. Due to severe calcification of the anterior descending artery, 4-cm long arteriotomy was performed, followed by prolonged shuntoplasty of the arteriotomic incision of the left internal mammary artery with anterior descending artery in the area of stenosis through the calcified atherosclerotic plaque. The diameter of the target coronary arteries at the site of distal anastomoses was less than 1.5 mm. The postoperative period turned out uneventful with no complications. The patient was discharged on POD 8. In order to prevent shunt thrombosis, the patient was prescribed to receive dual antiplatelet therapy for 1 year (aspirin and clopidogrel), as well as therapy with statins (atorvastatin 80 mg). The control examination at 12 months revealed no clinical signs of ischemia return. The findings of MSCT bypass angiography confirmed patency of all shunts.

Conclusion: The use of microsurgical techniques, an operating microscope, and coronary reconstructions as shuntoplasty makes it possible to perform coronary artery bypass grafting in severe coronary artery disease with satisfactory clinical outcomes.

背景:冠状动脉弥漫性动脉粥样硬化累及远端血管、广泛钙化、冠状动脉直径小是冠心病患者拒绝介入治疗的原因。对于这些患者,手术治疗的唯一选择是冠状动脉旁路移植术,但它与远端吻合口的创建技术困难和较差的长期生存有关。然而,显微外科技术的应用使成功治疗此类患者成为可能。患者与方法:59岁男性冠心病患者,择期行冠状动脉旁路移植术。冠状动脉造影显示多血管弥漫性病变伴冠状动脉钙化。根据句法评分估计冠状动脉粥样硬化的严重程度为39分。多层计算机断层扫描证实严重的冠状动脉远端三支血管钙化。结果:在手术显微镜和人工循环下,采用延长吻合(2 cm长)的方法,经动脉粥样硬化斑块行对角动脉、钝缘动脉和后降支自体静脉旁路移植术。因前降支钙化严重,行长4cm的动脉切开术,通过钙化的动脉粥样硬化斑块,在狭窄区左乳内动脉与前降支的动脉切开术切口行长时间的分流成形术。远端吻合处靶冠状动脉直径小于1.5 mm。术后顺利,无并发症发生。患者于POD 8出院。为预防分流血栓形成,患者给予双抗血小板治疗1年(阿司匹林和氯吡格雷),同时给予他汀类药物治疗(阿托伐他汀80 mg)。12个月的对照检查未发现缺血复发的临床迹象。MSCT旁路血管造影结果证实所有分流通畅。结论:应用显微外科技术、手术显微镜和冠状动脉重建术作为分流成形术,可以对重症冠状动脉病变进行冠状动脉旁路移植术,临床效果满意。
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引用次数: 0
[Mycotic aneurysm of the abdominal aorta. Review and own clinical experience]. 腹主动脉的真菌性动脉瘤。回顾和自己的临床经验]。
Q3 Medicine Pub Date : 2022-09-30 DOI: 10.33029/1027-6661-2022-28-3-44-55
A V Maksimov, A Yu Teregulov, M V Plotnikov, A V Postnikov

Mycotic (infectious) aneurysm is a rare pathology resulting from infectious destruction of the artery. Approximately 0.65-2% of aortic aneurysms in Europe are of infectious nature, in Asia this rate is higher. The most common pathogens are salmonellae (predominant in Asia) and staphylococci (predominant in European and North American patient populations) - about 40% of the total number of cultured organisms. Diagnosis is based on the clinical picture (pain, fever, sepsis), and laboratory tests include inflammatory markers. Characteristic morphological signs: baggy, sometimes multi-chambered arterial wall protrusion, perivascular edema, hematoma and/or fi brous tissue. The presence of perivascular gas and rapid aneurysm growth are pathognomonic symptoms. Currently, there is no international consensus on the optimal treatment of mycotic aneurysms, but the extremely unfavorable prognosis makes surgical treatment necessary regardless of aneurysm size. Two strategies are used - open aneurysm resection with in situ reconstruction or extraanatomic revascularization and stent-graft implantation. In both cases, prolonged antibiotic therapy is required. According to the literature, its duration should be at least 6-8 weeks, and possibly longer, up to lifelong. The main disadvantage of endovascular method is the lack of open surgical sanation of septic focus. Nevertheless, the available literature data suggest that the integral results of open surgery and X-ray endovascular techniques are comparable. It is impossible to draw statistically reliable conclusions due to the small number of observations - available clinical reports do not exceed dozens of cases. This article describes two cases of mycotic aneurysm of the infrarenal aorta. In the first case (male, 60 years old), aortic endoprosthesis was performed, followed by open sanation and drainage of retroperitoneal space and antibacterial therapy for 6 weeks (until clinical and laboratory signs of systemic infection normalized). There was no recurrence at 14 months follow-up. In the second observation (male, 62 years old), the diagnosis of mycotic aneurysm was not established. Endoprosthesis of a ruptured infrarenal aortic aneurysm was performed. Absence of massive antibiotic therapy resulted 3 months later in the manifestation of local infectious process with the development of fatal complication - aortoduodenal fistula with fatal bleeding.

霉菌性(感染性)动脉瘤是一种罕见的由动脉感染性破坏引起的病理。在欧洲大约0.65-2%的主动脉瘤是感染性的,在亚洲这个比例更高。最常见的病原体是沙门氏菌(主要在亚洲)和葡萄球菌(主要在欧洲和北美患者群体中)——约占培养生物总数的40%。诊断是基于临床表现(疼痛、发热、败血症)和实验室检查包括炎症标志物。特征性形态征象:松弛,有时多腔动脉壁突出,血管周围水肿,血肿和/或纤维化组织。血管周围气体的存在和动脉瘤的快速生长是典型的症状。目前,对于真菌性动脉瘤的最佳治疗方法尚无国际共识,但由于其预后极其恶劣,无论动脉瘤大小如何,都必须进行手术治疗。采用两种治疗策略:动脉瘤切开切除并原位重建或解剖外血管重建术和支架植入术。在这两种情况下,都需要长期的抗生素治疗。根据文献,其持续时间应至少为6-8周,可能更长,直至终生。血管内法的主要缺点是对脓毒性病灶缺乏开放的手术卫生。然而,现有的文献资料表明,开放手术和x线血管内技术的整体结果是相当的。由于观察数量少,不可能得出统计上可靠的结论——现有的临床报告不超过几十个病例。本文描述了两例肾下主动脉的真菌性动脉瘤。第一例患者(男性,60岁)行主动脉腔内修复术,随后进行开放清洁和腹膜后间隙引流,并进行抗菌治疗6周(直至临床和实验室体征全系统感染正常化)。随访14个月无复发。在第二次观察中(男性,62岁),霉菌性动脉瘤的诊断没有确定。我们对一个破裂的肾下主动脉瘤进行了人工植入术。由于缺乏大量抗生素治疗,3个月后表现为局部感染过程,并发致命并发症-主动脉十二指肠瘘并致命出血。
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引用次数: 0
[Pseudoaneurysm and posttraumatic arteriovenous fistula in the basin of the external iliac artery (case report)]. [髂外动脉盆内假性动脉瘤和创伤后动静脉瘘(1例报告)]。
Q3 Medicine Pub Date : 2022-09-30 DOI: 10.33029/1027-6661-2022-28-3-103-107
A A Rabtsun, I V Popova, Sh B Saaya, A A Gostev, A V Cheban, S V Bugurov, P V Ignatenko, A A Karpenko

In peacetime, the incidence of posttraumatic arteriovenous fistulas is relatively low. Therapeutic specialists are not, as a rule, watchful towards detecting this pathology. In atypical localizations of arteriovenous fistulas, manifestation of the disease may be in the form of signs of cardiac insufficiency. Therefore, such patients are rarely referred to a surgeon. We present herein a case of successful surgical treatment of a 40-year-old patient with a posttraumatic false aneurysm of iliac arteries and arteriovenous fistula, manifesting for many years as a clinical course of cardiac insufficiency. We performed suturing of the arteriovenous fistula and prosthetic repair of iliac arteries on the right. According to the findings of control contrastenhanced multislice spiral computed tomography, the prosthesis functions satisfactorily, with no arteriovenous shunts.

在平时,创伤后动静脉瘘的发生率相对较低。一般来说,治疗专家对发现这种病理并不注意。在不典型定位的动静脉瘘,疾病的表现形式可能是心功能不全的迹象。因此,这样的病人很少被转诊给外科医生。我们在此报告一例成功手术治疗的40岁患者创伤后假动脉瘤髂动脉和动静脉瘘,表现为多年的临床过程心功能不全。右侧行动静脉瘘缝合及髂动脉假体修复术。对照对比增强多层螺旋计算机断层扫描结果显示,假体功能良好,无动静脉分流。
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引用次数: 0
Use of fenestrated stent grafts in treatment of acute aortic syndrome. 开窗支架在急性主动脉综合征治疗中的应用。
Q3 Medicine Pub Date : 2022-09-30 DOI: 10.33029/1027-6661-2022-28-3-56-67
T N Khafizov, I A Idrisov, V V Kataev, I E Nikolaeva, T E Imaev, E E Abkhalikova, I E Yamanaeva

Objective: To study the possibility and determine the safety of using stent grafts with on table and in situ fenestration in patients with acute aortic syndrome.

Patients and methods: From 2019 to 2021, specialists of the Republican Cardiological Center (Ufa) retrospectively analyzed the results of endovascular treatment of 34 patients with acute aortic syndrome.

Results and discussion: All 34 patients were operated on within the first 48 hours after the disease was detected. They were subjected to various types of endovascular debranching. In 26 patients, zone 2 according to Ishimaru was selected with on table or in situ TEVAR (Thoracic Endovascular Aortic Repair) of the left subclavian artery; in 6 cases, double fenestration of the left common carotid and left subclavian arteries were performed during implantation into zone 1 according to Ishimaru. In 2 cases, total endovascular debranching was performed during implantation into zone 0 according to Ishimaru. The average operation time was 137.35±61.4 minutes, the average contrast consumption was 295.2±79.2 ml, and the average volume of blood loss was 78±121.1 ml. In all cases, the technical success was 100%, however, during the control MSCT, 2 cases of type 3 endoleaks were identified, which were further embolized. One patient developed retrograde dissection of the ascending aorta and the aortic arch 2 months after surgery. Further surgical correction was performed. Overall in-hospital mortality was 0%, and only 3 (8.8%) patients died in the remote period.

Conclusion: Thoracic endovascular aortic repair (TEVAR) of the aortic arch with various types of endovascular debranching can be considered as an alternative and effective method for treatment of patients with acute aortic syndrome.

目的:探讨急性主动脉综合征患者在手术台上原位开窗支架移植的可行性及安全性。患者和方法:2019 - 2021年,共和心脏病中心(Ufa)的专家回顾性分析了34例急性主动脉综合征患者的血管内治疗结果。结果与讨论:34例患者均在发现病变后48小时内手术。它们遭受不同类型的血管内分支脱支。在26例患者中,根据Ishimaru选择2区,对左侧锁骨下动脉进行手术台上或原位TEVAR(胸椎血管内主动脉修复术);6例患者在1区植入时,行左侧颈总动脉和左侧锁骨下动脉双开窗术。2例患者根据Ishimaru在0区植入时行血管内全脱支。平均手术时间137.35±61.4分钟,平均造影剂消耗295.2±79.2 ml,平均失血量78±121.1 ml。所有病例技术成功率均为100%,但在对照MSCT期间,发现2例3型内漏,并进一步栓塞。1例患者术后2个月出现升主动脉和主动脉弓逆行夹层。进一步进行手术矫正。总体住院死亡率为0%,远程期间仅有3例(8.8%)患者死亡。结论:胸椎主动脉弓血管内主动脉修复术(TEVAR)可作为治疗急性主动脉综合征的一种有效的替代方法。
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引用次数: 0
[Successful endovascular treatment of acute myocardial infarction in patients with novel coronavirus infection COVID-19 (case reports)]. 【新型冠状病毒感染COVID-19急性心肌梗死血管内治疗成功(附病例报告)】。
Q3 Medicine Pub Date : 2022-09-30 DOI: 10.33029/1027-6661-2022-28-3-120-127
A A Fokin, K A Kireev, K A Rudneva, V V Fistakovskiy

Presented herein are two clinical case reports regarding endovascular treatment of acute myocardial infarction in patients with the new coronavirus infection COVID-19. The first clinical case report describes the development of acute myocardial infarction in a 60-year-old male patient with the novel coronavirus infection and bilateral pneumonia (60% lesion of the lung parenchyma) with neither significant atherosclerotic process in coronary arteries nor cardiovascular risk factors. Acute myocardial infarction was characterized by isolated thrombosis of the right coronary artery. In the second case report, a 72-year-old woman was diagnosed as having atherosclerotic pathology of coronary arteries with unstable plaques and a predisposition to intracoronary thrombus formation. She was found to have critical stenoses of the anterior descending and circumflex branches of the left coronary artery, uncontrolled arterial hypertension, and dyslipidemia. Discussed in the article are technical peculiarities of coronary interventions in patients with COVID-19, accompanied and followed by analyzing clinical patterns of the diseases involved.

本文报道两例新型冠状病毒感染COVID-19急性心肌梗死患者血管内治疗的临床病例。首例临床病例报告描述了一名60岁男性新型冠状病毒感染合并双侧肺炎(肺实质病变60%)的急性心肌梗死的发展,冠状动脉无明显动脉粥样硬化过程,也无心血管危险因素。急性心肌梗死的特征是孤立的右冠状动脉血栓形成。在第二个病例报告中,一名72岁的女性被诊断为冠状动脉粥样硬化病理,伴有不稳定斑块和冠状动脉内血栓形成的易感性。她被发现有左冠状动脉前降支和旋支的严重狭窄,不受控制的动脉高血压和血脂异常。本文讨论了COVID-19患者冠状动脉介入治疗的技术特点,并分析了所涉及疾病的临床模式。
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引用次数: 0
[Surgical treatment of iliofemoral phlebothrombosis using transjugular thrombextraction]. [经颈静脉取栓术治疗髂股静脉血栓]。
Q3 Medicine Pub Date : 2022-09-30 DOI: 10.33029/1027-6661-2022-28-3-86-92
A N Khuziakhmedov, I G Khalilov, R N Komarov

Objective: The study was aimed at reducing the risk for the development of intraoperative embolism during thrombectomy from the iliofemoral venous segment. Danger of surgical treatment of patients with phlebothrombosis of the iliofemoral segment with flotation remains of current concern primarily due to the risk of pulmonary embolism. The authors worked out a method of surgical treatment making it possible to decrease the risk of this complication. This method was used in a total of 34 patients diagnosed with acute deep vein thrombosis. All patients, both preoperatively and in the early postoperative period, underwent chest and abdominal contrast-enhanced X-ray computed tomography, ultrasonographic duplex scanning of veins of both lower limbs. After making the fi naldiagnosis, all patients were subjected to surgical treatment: transjugular thrombectomy from the iliocaval and femoral segments, with no postoperative complications observed. All patients were discharged in a satisfactory condition to be followed up by district surgeon. The iliofemoral segment remained patent during the whole follow-up period, with no evidence of rethrombosis.

Conclusion: The developed method of transjugular thrombextraction from the iliocaval and femoral segments for phlebothrombosis makes it possible to safely restore patency of veins in the involved segment with minimal risk of both intra- and postoperative complications.

目的:本研究旨在降低髂股静脉段取栓术中发生栓塞的风险。髂股段静脉血栓形成患者的手术治疗的危险仍然是目前关注的主要原因是肺栓塞的风险。作者提出了一种手术治疗方法,可以降低这种并发症的风险。本方法共用于34例急性深静脉血栓患者。所有患者术前及术后早期均行胸腹x线增强ct、双下肢静脉超声双扫描。确诊后,所有患者均行手术治疗:经颈静脉髂腔及股段取栓,无术后并发症。所有患者出院情况良好,由地区外科医生随访。在整个随访期间,髂股段保持通畅,无血栓形成的迹象。结论:发展的髂腔和股段经颈静脉取栓治疗静脉血栓形成的方法可以安全地恢复受病段的静脉通畅,并且减少了术中和术后并发症的风险。
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引用次数: 0
[Emergency surgical and endovascular revascularization in high-surgical risk patients with non-ST segment elevation acute coronary syndrome]. 非st段抬高急性冠状动脉综合征高危患者的急诊手术及血管内重建术
Q3 Medicine Pub Date : 2022-09-30 DOI: 10.33029/1027-6661-2022-28-3-77-85
A B Nishonov, R S Tarasov, K A Kozyrin, S V Ivanov, V I Ganykov

Background: There is a limited number of studies concerning the results of urgent coronary artery bypass grafting (CABG) in high-surgical risk patients with non-ST elevation acute coronary syndrome. Deficit of an evidence-supported base is related to peculiarities of organization and availability of emergency CABG, the process of decision-making, and a series of tactical and technical aspects of performing this type of intervention within the first 24 hours in high-surgical risk patients with manifest symptoms of ischemia and myocardial lesion in severe multivessel coronary atherosclerosis and involvment of the left coronary artery trunk.

Objective: The purpose of this study was to carry out a comparative analysis of the inhospital outcomes of emergency surgical and endovascular revascularization (CABG and percutaneous coronary intervention) in high-surgical risk patients with non-ST elevation acute coronary syndrome.

Patients and methods: In our retrospective study with propensity score matching, we analyzed the in-hospital results of CABG (n=67) and percutaneous coronary intervention (n=67) in high-surgical risk patients with non-ST-segment elevation acute coronary syndrome within the first 24 hours after admission. The patients had severe lesions of coronary arteries with a median of the SYNTAX score of 24 points. The endpoints of the study were all-cause mortality, cardiac mortality, myocardial infarction, repeat non-elective revascularizations, and a composite endpoint combining all the above enumerated events. Besides, we evaluated completeness of the scope of myocardial revascularization in the groups.

Results: The patients in the groups were comparable by the main clinical and anamnestic data which was ensured by propensity score matching. The majority of CABGs were performed in conditions of artificial circulation. In the group of percutaneous coronary intervention, the strategy of multivessel and staged stenting was used approximately in a similar proportion (47.8 and 52.2%, respectively). There were no significant differences between the groups of CABG and percutaneous coronary intervention by the endpoints. Mortality from cardiac causes in the groups turned out to be similar, each amounting to 4.5%. CABG was characterized by significantly higher frequency of complete myocardial revascularization as compared with percutaneous coronary intervention: n=62 (92.5%) vs n=48 (71.6%), respectively, p=0.001.

Conclusion: Urgently performed CABG demonstrated comparable with percutaneous coronary intervention in-hospital results of revascularization in high-surgical risk patients with severe multivessel lesions with non-ST elevation-acute coronary syndrome, ensuring fuller scope of myocardial revascularization as compared with percutaneous coronary intervention.

背景:关于紧急冠状动脉旁路移植术(CABG)治疗非st段抬高急性冠状动脉综合征高危患者的结果的研究数量有限。缺乏证据支持的基础与紧急冠状动脉搭桥的组织和可用性的特殊性、决策过程以及在24小时内对具有明显缺血和心肌损害症状的严重冠状动脉多支动脉粥样硬化和左冠状动脉干受累者的高手术风险患者实施此类干预的一系列战术和技术方面有关。目的:本研究的目的是比较分析急诊手术和血管内血管重建术(CABG和经皮冠状动脉介入治疗)治疗高危非st段抬高急性冠状动脉综合征的住院疗效。患者和方法:回顾性分析非st段抬高急性冠状动脉综合征高危患者入院后24小时内行冠脉搭桥(n=67)和经皮冠状动脉介入治疗(n=67)的结果。患者有严重的冠状动脉病变,SYNTAX评分中位数为24分。该研究的终点是全因死亡率、心脏死亡率、心肌梗死、重复非选择性血运重建术,以及结合上述所有事件的复合终点。此外,我们还评估了各组心肌血运重建范围的完整性。结果:两组患者的主要临床资料和记忆资料具有可比性,并通过倾向评分匹配得到保证。大多数cabg是在人工循环条件下进行的。在经皮冠状动脉介入治疗组中,采用多支和分期支架置入策略的比例大致相似(分别为47.8%和52.2%)。CABG组与经皮冠状动脉介入治疗组在终点上无显著差异。结果表明,这两组人的心脏病死亡率相似,均为4.5%。与经皮冠状动脉介入治疗相比,CABG的特点是心肌完全血运重建的频率明显更高:n=62 (92.5%) vs n=48 (71.6%), p=0.001。结论:紧急行冠状动脉搭桥与经皮冠状动脉介入治疗在非st段抬高急性冠状动脉综合征的高危多血管病变患者的院内血运重建效果相当,与经皮冠状动脉介入治疗相比,可确保更大范围的心肌血运重建。
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引用次数: 0
[Great surgeon Sergei Sergeevich Yudin (Through the eyes of an eyewitness)]. 伟大的外科医生谢尔盖·谢尔盖耶维奇·尤丁(通过目击者的眼睛)。
Q3 Medicine Pub Date : 2022-07-15 DOI: 10.33029/1027-6661-2022-28-2-12-18
Yu V Natochin

Yudin S.S. (1891-1954) outstanding physician, surgeon of the twentieth century. His achievements are associated with the development of a method for transfusion of postmortem blood to patient, reconstructive surgery of the esophagus, surgery of the stomach and duodenum, and traumatology. Yudin was encyclopedically educated, he is one of the organizers of the Academy of Medical Sciences of the USSR, he received recognition in our country (winner of two State Prizes, the Lenin Prize, member of Academy of Medical Sciences of the USSR) and the international medical community (honorary member of the Royal Society of Surgeons, etc.). In 1948-1953 he was repressed, completely rehabilitated. In 1952-1953 he was in exile in Novosibirsk, conducted research on the clinical physiology of the stomach and small intestine. In 1953 he returned from exile to Moscow and then fully rehabilitated.

尤丁(1891-1954)二十世纪杰出的内科医生、外科医生。他的成就与发展死后输血给病人的方法、食道重建手术、胃和十二指肠手术以及创伤学有关。尤丁受过百科全书式的教育,他是苏联医学科学院的组织者之一,他在我国(两次国家奖、列宁奖获得者、苏联医学科学院院士)和国际医学界(皇家外科医师学会荣誉会员等)受到认可。1948-1953年,他被镇压,完全平反。1952-1953年,他流亡新西伯利亚,进行胃和小肠的临床生理学研究。1953年,他结束流亡回到莫斯科,然后完全康复。
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引用次数: 0
[Surgical strategy in patients with combined symptomatic carotid and coronary artery lesions]. [颈动脉和冠状动脉合并症状病变的手术策略]。
Q3 Medicine Pub Date : 2022-07-15 DOI: 10.33029/1027-6661-2022-28-2-102-109
A N Vachev, O V Tereshina, O V Dmitriev, Yu S Belkin, P A Lebedev

Background: Currently, the approach to the management of symptomatic concomitant lesions of the carotid and coronary arteries remains controversial. No randomized trials on this issue have been conducted.

Objective: The purpose of this study was to validate the choice of surgical strategy in patients with significant symptomatic carotid and coronary artery lesions.

Patients and methods: Our single-center cohort prospective study included a total of 117 consecutively operated patients presenting with significant concomitant carotid and coronary artery disease. All patients underwent surgery at the Clinic of Faculty Surgery of the Samara State Medical University, being symptomatic in both carotid and coronary circulations. They were subdivided into two groups depending on the staging of surgical treatment: 42 patients were subjected to one-stage surgical intervention [carotid endarterectomy (CEA) + coronary artery bypass grafting (CABG) during single anesthesia] and the remaining 75 patients underwent two-stage surgery (CEA at the first stage, followed by CABG performed within not more than a 3-month period). The groups were comparable by most parameters. The primary endpoints were stroke and myocardial infarction, as well as mortality from stroke and mortality from myocardial infarction in the perioperative period.

Results: There were no significant statistical differences in the incidence of myocardial infarction, stroke, and perioperative mortality between the two groups (p>0.05). A risk factor significantly associated with perioperative stroke appeared to be the presence of transitory ischemic attacks (TIAs) during 6 months before surgery (OR 18.400; 95% CI, p=0.002). Risk factors for perioperative myocardial infarction were the occurrence of postoperative bleeding and resternotomy (OR 12,333; 95% CI, p=0.021). A risk factor for patient death was the presence of TIAs within 6 months before surgery (OR 7.360; 95% CI, p=0.019).

Conclusions: Two-stage or one-stage surgical tactics in symptomatic patients with significant ICA and coronary artery disease had similar rates of perioperative myocardial infarctions, cerebrovascular events, and mortality. The main risk factors for the development of adverse outcomes in these patients were the presence of TIA during 6 months before surgery, as well as postoperative bleeding combined with resternotomy.

背景:目前,颈动脉和冠状动脉症状性病变的治疗方法仍存在争议。在这个问题上没有进行随机试验。目的:本研究的目的是验证有明显症状的颈动脉和冠状动脉病变患者的手术策略的选择。患者和方法:我们的单中心队列前瞻性研究共纳入117例伴有明显颈动脉和冠状动脉疾病的连续手术患者。所有患者均在萨马拉国立医科大学外科学院诊所接受手术,颈动脉和冠状动脉循环均出现症状。根据手术治疗分期将患者分为两组:42例患者接受一期手术干预[颈动脉内膜切除术(CEA) +单麻醉下冠状动脉旁路移植术(CABG)],其余75例患者接受两期手术(第一阶段颈动脉内膜切除术,随后在不超过3个月的时间内进行CABG)。两组在大多数参数上具有可比性。主要终点是卒中和心肌梗死,以及围手术期卒中死亡率和心肌梗死死亡率。结果:两组患者心肌梗死发生率、脑卒中发生率、围手术期死亡率比较,差异均无统计学意义(p < 0.05)。术前6个月出现短暂性脑缺血发作(tia)是围手术期卒中显著相关的危险因素(OR 18.400; 95% CI, p=0.002)。围手术期心肌梗死的危险因素为术后出血和胸腔切开术(OR 12,333; 95% CI, p=0.021)。患者死亡的一个危险因素是术前6个月内出现tia (OR 7.360; 95% CI, p=0.019)。结论:对于有明显ICA和冠状动脉疾病症状的患者,两期或一期手术策略围手术期心肌梗死、脑血管事件和死亡率相似。这些患者发生不良结局的主要危险因素是术前6个月出现TIA,以及术后出血合并胸腔切开术。
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引用次数: 0
[Alterations in the structure of patients with acute limb arterial ischemia]. [急性肢体动脉缺血患者的结构改变]。
Q3 Medicine Pub Date : 2022-07-15 DOI: 10.33029/1027-6661-2022-28-2-45-49
N G Khorev, S V Sapelkin, A V Beller, A A Chichvarov

Background: In the structure of surgical events, acute limb ischemia is a cause of death in 25-30% of patients.

Objective: The present study was aimed at examining the structure of patients with lower and upper limb acute ischemia in the Barnaul urban agglomeration.

Patients and methods: We analyzed a total of 1,366 patients presenting with arterial embolism or limb thrombosis within 14 days after the onset of the acute event and hospitalized to the Department of Vascular Surgery during 2000-2018. The epidemiological index of acute limb ischemia amounted to 10.1 per 100 thousand people per year, being comparable with the data of the international statistics. Of these, 865 patients were hospitalized during 2000-2010, and 501 during 2011-2018.

Results: Comparing the groups demonstrated an increased number of hospitalizations of women (from 4.6 to 5.3 per 100 thousand/year) in the structure of all patients with acute ischemia, a statistically significant decrease in the number of patients with arterial thromboses, and an increase in the number of those admitted with arterial embolisms. We revealed a tendency to a decrease in the overall number of hospitalized patients and an increase in the number of patients with stage II-III arterial ischemia, with upper limb ischemia diagnosed significantly more often (from 1.4. to 3.2 per 100 thousand/year).

Conclusion: Along with a trend towards a decrease in the total number of hospitalized patients with acute limb ischemia, we revealed an increase in the number of patients with acute limb ischemia in the presence of arterial embolism and a decreased number of patients with acute arterial thrombosis.

背景:在外科事件的结构中,急性肢体缺血是25-30%患者死亡的原因。目的:研究巴瑙尔城市群下肢和上肢急性缺血患者的组织结构。患者和方法:我们分析了2000-2018年期间血管外科住院的1366例急性事件发生后14天内出现动脉栓塞或肢体血栓形成的患者。急性肢体缺血流行病学指数为10.1 / 10万人/年,与国际统计数据相当。其中,2000-2010年住院患者865例,2011-2018年住院患者501例。结果:两组比较表明,在所有急性缺血患者的结构中,女性住院人数增加(从4.6到5.3 / 10万/年),动脉血栓患者人数减少,动脉栓塞患者人数增加。我们发现住院患者的总人数有减少的趋势,而II-III期动脉缺血患者的人数有增加的趋势,上肢缺血的诊断明显更多(从1.4。至每10万人/年3.2人)。结论:随着急性肢体缺血住院总人数的减少,我们发现伴有动脉栓塞的急性肢体缺血患者数量增加,伴有急性动脉血栓形成的患者数量减少。
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引用次数: 0
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Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery
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